Was Evan Bayh right about health reform? When?

By
Ezra Klein

I'm a big fan of Sen. Evan Bayh's critique of the U.S. Senate. But I'm a bit confused by his critique of the 111th Congress's accomplishments. Responding to the results of the recent midterm election, he wrote:

We also overreached by focusing on health care rather than job creation during a severe recession. It was a noble aspiration, but $1 trillion in new spending and a major entitlement expansion are best attempted when the Treasury is flush and the economy strong, hardly our situation today.

As I learned in reporting for my upcoming book, The Promise: President Obama, Year One, out in May, White House aides David Axelrod and Jim Messina visited the Senate just before the August recess last year and left feeling much better after hearing from Bayh. He made them feel that the politics of getting reelected demanded passage of the bill, which at the time looked iffy. "We're all screwed if you don't get something real on health care," Bayh told them. This made Axelrod and Messina think that the moderates would be on board.

The two statements aren't impossible to reconcile: Maybe Bayh thought the politics favored passing a bill then, but he's reconsidered that judgment as the months have gone by. Still, it's a reminder that even people like Bayh thought Democrats were more doomed if the bill failed than if it passed. I was one of those people, in fact, and I still think that judgment was correct. The election was pretty bad for the Democrats, but it would've been even worse if the portion of the Democratic base that really cared about the health-care reform bill had gotten demoralized and stayed home.

And all of this ignores the minor matter of the enormous good the bill will do. Read Will Saletan for more on that.

"We're all screwed if you don't get something real on health care," Bayh told them. This made Axelrod and Messina think that the moderates would be on board"

We did not get something real on health care. We got some good pieces, no preexiting conditions, and PERHAPS coverage for adult children in exchange for numbers that are complete nonsense.

An interesting story in the Post today explains why HCR will never save even one dollar let alone 140 billion.

Provenge, a vaccine for advanced stage prostate cancer is awatiing final approval. It has shown to extend the lives of patients only 4 months but costs about $100,000. If approved Medicare coverage is almost automatic.

If I was in that situation would I want to take it? Possibly, although my sister's quality of life was not good for the time that chemotherapy for her pancreatic cancer extended it. However given that this is a drug for older American males, and they are the most consistent voting bloc, it will be impossible for Medicare NOT to pay for this drug.

Nothing that is in the bill will even remotely address this concern, not insurance markets, not "Medicare reform" which is about reducing payments to providers and will never happen.

End of life treatments and transplants will only increase exponentially. The inclusion of those with pre-existing conditions, those MOST likely to require medical treatment, while a huge benefit to individuals and morally good for society, will cost far beyond any current estimates, as treatment choices continue to expand

Ezra, I think you're a touch off on the finish. I think a fair number of left types did get significantly demoralized by the overly compromised health care bill and that that reduced Dem turnout. If a public option had been included -- and if more of the positive value of reform had been front loaded rather than put off til 2014 -- Dem morale and turnout would have been a few percentage points stronger.

Also on the demoralization front: hand-holding with Wall Street. The consumer financial board thing, as legit as it might be, just isn't enough to get anyone's blood boiling.

I think one of the major under-discussed "what-ifs?" of the recent election is "What if Lieberman had not deep-sixed Medicare buy-in for 55 year-olds when it looked like it was gaining momentum as part of potential health care reform in lieu of the public option?"
I personally think that a lot of the anti-health reform animus that drove seniors to vote in droves for Republicans would have been dissipated by Medicare buy-in.
Further, I think that it is ironic that Lieberman basically tanked the proposal because too many "hippies" like Howard Dean thought it was a great idea, yet it was self-described "moderates" of the Lieberman, Bayh, Melissa Bean, etc. type that would have really benefited politically from the idea.

54465446:
"An interesting story in the Post today explains why HCR will never save even one dollar let alone 140 billion."

Could you please paste the link for the story you refer to? I've been making the case for months that the $140 billion 'deficit reduction' Ezra keeps regurgatating evaporating months ago with a series of estimate 'corrections' that came out after the bill was passed.

I'm interested to see who at the Post finally found their journalistic integrity and posted the facts to set Ezra straight.

I overstretched the meaning of my sentence. I was speaking about the story on Provenge the vaccine for prostate cancer awaiting approval...

Point being that current estimates of Medicare spending do not take into account endless new treaments that will be added raising the cost.

If you want the basic information, look up Medicare sustainable growth rates formula SGR. In their estimate of cost savings as quantified by the CBO, the administration used a backed up SGR of 21%. I say backed up because the formula results in "automatic" cuts in payments to medicare providers unless waived by Congress. These had been waived off the last 6 times since 2002, resulting in a backed up number of 21% which was a major source of cost savings. Trouble was, Congress waived off the cuts, almost immediately AFTER passing the bill that included these cuts in the estimates. Nice way to do business eh?

Sorry for my mangled sentence structure. I write on a lot of threads and do a poor job sometimes.

He was right, and I don't think the statements are contradictory. In February, if we had folded on health care it would have been still aligned with Democratic malfeasance, so we had to pass it. I think Bayh's current statement was that the entire effort of health care reform before the economy had shown tangible signs of recovery was poor planning in the political sense. We should have put it after a big job-creation bill.

So by February, since we had already burned so much political capital on health care reform, we had to pass it. But, in the beginning, we should have prioritized job-creation policy before health care reform.

Or we could have gone with single-payer and therefore coupled them together with a campaign of creating jobs by getting health insurance costs away from employers, but Democrats seem to simply suck at messaging and unions only promote loyal organizers to their communications staffs rather than communications professionals. It's the sad tragedy of lefty governance.

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